'Behind the Blue': Rebecca Dutch Discusses Current Efforts in Fighting COVID-19

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KODY KISER: Thank you for joining us again on another episode of the "Behind the Blue" podcast. I'm Kody Kiser with UK Public Relations and Strategic Communications. I'm joined this week by UK Chief Communications Officer Jay Blanton. And our guest on this episode is a returning guest from last spring, Dr. Rebecca Dutch. Dr. Dutch is a professor and chair in the Department of Molecular and Cellular Biochemistry here at UK. She received a BS in biochemistry, a BS in microbiology from Michigan State University in 1986, and then completed a MPhil degree in biochemistry from Cambridge University focusing on plant biochemistry.

Dr. Dutch, thank you for coming back to be on the podcast with us. And I think first things first, right out of the gate, we just want to kind of catch up on kind of where we are in our current state of play, as Jay likes to put it.

REBECCA DUTCH: So we are still in a COVID crisis. But I think we do see some potential light at the end of the tunnel. In terms of total numbers of infections, as predicted, after both Thanksgiving and Christmas we saw big ramp-ups. And thankfully, in most places, we're seeing a decrease in new case numbers now.

We still haven't flattened out the number of deaths, for instance, in Kentucky. That was still going up as of a day or so ago, when I was checking it. But those generally trail case numbers by two to three weeks. So we've been dealing with a huge number of COVID cases in this country over the last few months. It has very much stressed our health care systems. It is not the time for us to be careless, because there's a large amount of cases in our community. So each time we go out, we run a very high chance that we could be exposed. So those are the real negatives.

The positives-- number one, that the vaccine rollouts are really starting. So both the Moderna and Pfizer vaccines are rolling out. UK has obviously being a critical part of that effort in vaccinating people in this region. The Moderna and Pfizer vaccine efficacy after two doses is outstanding. And that presents a real opportunity for us to get past this eventually, to get back to what we consider a normal means of existence.

There's also a hope-- we're waiting to hear. Johnson & Johnson will release their phase three trial very soon. And they have already scaled up. So if they are indeed also-- if that's also going to work, then we'd have, by March we think, another major source of vaccine coming out. So those are huge changes.

And many of our health care workers have already been vaccinated. Kentucky is in the middle of our K-12s right now. We're getting older people vaccinated. So many of our higher risk people are getting vaccinated. And that should really reduce our death polls going forward. So those are all really, really good things.

There's a goal to have everybody vaccinated by the end of the summer, that was just put out by the new administration. Again, once we're all vaccinated, it's a game changer. And if you want to see how much a game changer-- Israel's vaccinated a huge portion of their population. And the curves are amazing. So it really, really matters.

So in that sense, that's very much where we are. But we have to get to that point. So that means in the spring, we have to continue to be very mindful of our behavior, very respectful of how we are around others to make sure we reduce chances of transmission.

KODY KISER: Going back to the first point that you mentioned about our case numbers going up, I think it's probably important to point out or talk about the fact that when we talked in the spring, our case numbers were jumping in major metropolitan areas, very compact, urban areas. But for the last several months or longer, we've really seen a lot of this spread unchecked in rural areas.

REBECCA DUTCH: Absolutely.

KODY KISER: Where there's not a lot of population, but the population that is there, it is really spreading unchecked.

REBECCA DUTCH: Yes. And that was something that a lot of people who work in virology and epidemiology would have predicted. But I think it still took people by surprise. I think it was easy back in the spring to think, oh, this is just a big city problem. This is just New York's problem, or New Orleans's problem, because they had a major problem in the spring.

But by now, some of the states with the highest mortalities-- meaning you look at how many people died per million in population, states like North and South Dakota are really bad now. They have a very high death per million in their population. That's because it's spreading right through all of those areas. It spreads easier when you have a lot of people close together, but over time, as more and more people get the virus, within a home or a family or a small community, you can still spread it very easily.

KODY KISER: I'm guessing that part of that, too, is in a larger city, you have enough people that are overwhelming the health systems there. But in a rural area, you just don't have the health systems, that availability, because of--

REBECCA DUTCH: Yes. That's what the problem is. In the larger cities, you're going to have total beds filled. So we probably all read about LA hitting capacity in many of their ICUs and things. But smaller regional hospitals and rural hospitals will often have very, very low capacity. So normally, they would then move people on to the larger health systems. But sometimes in some cases, that hasn't been easily available.

UK has still had availability and has really done a great job dealing with COVID patients. But certainly, there've been places in the country when it was difficult to find hospitals to take patients. So it has really impacted us across the country. I think Alaska's had a little less issues, but they've still got it-- same with Hawaii. But most of the 50 states really have had major problems with COVID at this point.

JAY BLANTON: Yeah, the new administration-- we talked a little bit about them. They have indicated they think the next couple of months could be the darkest months of this virus. Aside from the holiday surge of Christmas and New Year's, which we hope are kind of past, maybe, or are getting past, what are the factors that make the next couple of months-- even with the vaccines on the horizon here, what are the next couple of months that make things so potentially dark?

REBECCA DUTCH: There's a couple of things that we really worry about. One is while the total new case numbers is going down, once people are hospitalized with COVID, many of them stay in the hospital for a very long time. So many of our hospitals are still overwhelmed with the people that were brought in December or early January. And it's not unusual to have people stay in the ICU for many weeks with COVID, which for many other illnesses, it's usually a much shorter time. So that means we're going to be already starting with overcrowding situations.

The other thing is that anything that puts us in closer proximity to people and indoors tends to make it easier to spread a pathogen like this one. And it's wintertime in most of the US. It's cold out there in most of the US. And so people are much less likely to be indoors. That behavior we used to have in October when you had a friend come over and you'd all sit on the back porch-- people are not going to want to sit on the back porch right now. So they're much more likely to engage in indoor behavior that puts them at higher risk.

So I think those kinds of factors are really influencing. And we saw kind of a flip in the summertime. Florida had a big surge. But in the summertime in Florida, everybody is always inside. It's hot. You all go in where it's air conditioned. And here, we're all indoors because it's cold.

JAY BLANTON: We're hearing now about new variants, a British variant, the South African variant, the Brazilian variant. Give us some perspective. How big a problem is that? What makes it a problem? How do we need to think about it?

REBECCA DUTCH: So, variants were expected from the beginning. SARS-CoV-2 as a coronavirus, it's material that tells what it is. Its genetic material is made up of RNA. And we know that mistakes get made. It makes its copies with better what's called fidelity than most RNA viruses, because it does some of what's called proofreading, just fixing some of its errors. But it's still nowhere near as good as, say, when our cells make new copies of our DNA. So we expect some errors to occur.

And what happens with viruses, because when you infect a cell, you're making tens of thousands of new copies, if one is a little bit better, it may get picked up because it actually propagates a little bit better. Or maybe it moves from one person to another a little bit better. And over time, you get a slight change until you finally get a point where the virus in the population of the humans are in stable coexistence.

So we were not surprised to see things being picked up and [INAUDIBLE]. Around the world, and certainly here in Kentucky, they've been sequencing a percentage of cases to look and see if new things are popping up. So you expect that. But you want to follow it. And so there have been several variants that people are watching right now.

One, you heard of the UK variant. So this first came up in November. There is reasonable evidence that suggests it's more transmissible. So it's easier to move it from person to person. There has been one report that it might be more what's called pathogenic, and that's how sick it makes you or how likely you might be to die. But the data on that, I haven't seen it yet. There's not been much released. So at this point, we've also seen reports that say it isn't.

It's pretty clear it transmits a little bit better. And we know that-- we think the reason why is that it has a few changes in what's called the receptor binding domain. That's the protein on the virus, this thing that sticks out from the virus and hooks itself onto a cell. There's a couple of changes right in that hook site to-- you could almost think of it as making your Velcro a little tighter. So it's a little easier for it to attach on. And that's probably why it makes it a little more transmissible.

So that one is spreading. Yesterday, they announced the first identification of that variant in Kentucky. Apparently, two tests-- from what I was told this morning, it was single person, but they had given samples 10 days apart. It is not unlikely that we'll continue to see that one spread. It's spreading in the US slowly because it spreads better. Biggest thing with that is we just need to make sure we are extra careful about our precautions, that mask, that distancing. If you've got something that spreads better, we need to be even more careful than we ever were.

But all indications are that variant is blocked by our immune system. If we had COVID before, that variant's going to get recognized by our immune system. If we've been vaccinated, it looks like it's being recognized. You're protected for that one, too.

Two other variants-- Brazil, they're still doing studies on it. It had some similar things to the UK one. The other one that's raised a little more concern is one coming out of South Africa-- again, had some changes in the spike protein.

There's been one or two reports that suggest that you may have reduced protection to that variant compared to others. But those are very preliminary studies. It just looked at the blood from a patient who'd recovered and looked to see if that blood could neutralize the new variant. Doesn't take into account all the other parts of our immune system like T cells and other things that we know are active in fighting COVID.

There was a brief report from Moderna that suggested that their newest results say the Moderna vaccine is fine against that variant. But the other thing is all of these companies are going to be checking this constantly and using any new variants and checking them. And so we may eventually have a variant we have to have an adjusted booster dose. We'll see.

KODY KISER: And I wanted to mention or ask about that. The Pfizer and Moderna vaccines both target those spikes, the receptor spikes that attach.

REBECCA DUTCH: Right.

KODY KISER: So that's basically the foundation for those vaccines, is that that's what they go after. So it would seem like the positive that you might bring out of this is that if there is a variant that just basically changes the number of spikes or the stickiness of the spikes, that these vaccines are already targeting that. So you would hope that you already have--

REBECCA DUTCH: What you'll see when these changes happen-- so a spike is a large protein. I don't remember how many-- proteins are made up of these building blocks called amino acids. And a spike is 1,600, 1,700 of those together. And so you picture maybe 12 of them have changed. As long as those 12 aren't critical ones for the recognition of, say, our antibodies, then you're going to still be OK. And that's what they're continuing to check, that nothing new has been put in, that now we can't recognize-- nothing's been taken out that was a critical thing that we were recognizing.

So they are following it carefully. But so far, so good. And that spike is going to be the common thing for most vaccines. The new Johnson & Johnson vaccine, if indeed it is approved, it uses a different method of expression, but it's still spike that it's going after.

KODY KISER: Well, talking about the vaccines just a little bit, I think I-- correct me if I'm wrong. I think I saw this somewhere just in the last couple of days that the rollout has not been without challenges.

REBECCA DUTCH: Right.

KODY KISER: The thing that I read the other day was talking about we may be in a place where we are vaccinating maybe more people than we have new cases that are being confirmed. I don't know if that's true or not. But is that what we're looking for, to try to-- I know that the people who have already had it contribute to being somewhat resistant to it. But then also, you want to get your numbers up of how many people you're [INAUDIBLE].

REBECCA DUTCH: So long term, the goal would be to vaccinate the vast majority the United States population. Obviously, we're going to have to have cooperation in terms of people being willing to vaccinate. And there is vaccine hesitancy in some people.

Right now, eventually I think we will get to a point where per day, we're vaccinating more than the new cases that day that we had. But there'll still be a lot of people who have never had it and never been vaccinated. What eventually we want to do is to get to all of them.

You are right. You also brought up the fact that some people have had it already and they likely have protection. They do have protection. The vast majority of people who have had it before have some protection. They're still being recommended to have a vaccine, though, because the level of immune response from the vaccine is higher than it is-- particularly for people who have had asymptomatic cases or very low symptoms. For many of those, their overall response is lower than the response they get if they get vaccinated.

So eventually, yeah. We'll be tilting that balance. And I'm hoping by the time we're getting into the March and April period, we're able to say, oh, now we're down to maybe 30% of the population, 40% of the population that we still need to target to get these vaccines into. And that would put us in a much better place.

KODY KISER: Talking about how these vaccines work and looking at that kind of time frame, when you get the vaccine itself-- what is that process of when it begins to work? I mean, people don't get this and then they're automatically immune to it. There's obviously two rounds of shots for the Pfizer and Moderna vaccines.

REBECCA DUTCH: So let's talk about those two. The Johnson & Johnson one's a little different. So Pfizer and Moderna are both two-dose vaccines. Pfizer recommends three weeks between the doses. Moderna recommends four. And that's based on the timing they did their trials on. So that's what they know. Under these conditions, we get this level of protection.

So after your first shot, you absolutely have a nice immune response. I was fortunate because of the kind of work we do, I've had the Moderna shot already, the first one. And so I've been looking at this. Depending on the report, by 10 days out, you probably have somewhere between 50% and 80% protection, depending on which analysis you're looking at. So you're not completely protected. But you are lower risk.

But you need the booster to bump you up that extra level to be really what we consider well-protected. So after the booster, if you go a week to 10 days after the booster, you are now 95% protected from getting COVID that has any symptoms at all. And to date, there's not been a reported case of someone who's had both shots who's ended up in the hospital with COVID. So even that 5% that might get symptoms, they're still talking mild COVID compared to what you could get if you don't have these vaccines.

So a week to 10 days after your second vaccination, you, yourself, I would consider well-protected. The big question we don't know yet is whether you can still have enough virus replicating in your upper airways to spread it on to other people. If I had to make a guess, my guess would be we're going to find transmission is vastly reduced by these vaccines. But until they've done the studies, they don't want to count on that. And that's why they're really stressing whether or not you're vaccinated, have your masks on. Keep your distance until we know that for sure, because there are some vaccines that allow a little bit of replication.

Basically, you get the virus. Maybe the first day or two, it's a battle between your immune system and the virus. You are able to overcome it. That's why you never get symptoms. But maybe you had enough virus that if you stand next to someone and hug them, you might spread it. They need to make sure they rule that out before they tell you to just take those masks off.

JAY BLANTON: And we're hearing about this Johnson & Johnson one that's coming along. UK's played a role in being one of the clinical trial sites for that one. What's the difference between it as a one-shot vaccine that doesn't have to have this sort of deep refrigeration, for lack of a better word, or deep freeze, for lack of a better word? What's different about it than the other two that makes it that way? And should there be any concerns from what you know about the efficacy as a result?

REBECCA DUTCH: Well first, huge shout out to UK. If I understand it right, we were the largest site in terms of participation for the J&J trials, which is a huge shout out to UK. I've been so amazed with what people get done here.

So the Moderna and Pfizer vaccines are based on-- they're a messenger RNA vaccine. That means they take a piece of RNA that's like the script that tells you how to make the spike protein. They wrap it in some lipid so that your cells will take it up. Lipids are things our cells are made out of anyway. And that gets into cells.

Now, that lipid particle's not that stable. And so that's why the lower temperatures are needed. Moderna's are a little more stable than Pfizer's. That's what Pfizer's needs the ultra low freezers.

The J&J vaccine is actually based on an adenovirus. So adenovirus is a different virus. Some adenoviruses just cause common colds. And you can actually modify the adenovirus to express the different protein. And that's what's been done. This adenovirus has been first changed so that it doesn't replicate and make us sick. And then they've inserted into it the spike protein. So instead of its normal stuff, it had that spike protein just sitting out there.

So it's basically like an inert decoy that gets shoved into your body that goes around. Those adenoviruses are a lot more stable than that lipid particle with the mRNA in it. So that's why the-- so the J&J one, at least what I read, it looks like it needs to be refrigerated, but not frozen. We'll wait for final confirmation of that.

So that also seems to work fine after one shot. They're doing a one-shot trial with that. Adenoviruses that have been used before-- actually, the mRNA vaccines have been used in phase I trials for a number of different things prior to this. This is not the first uses of an mRNA vaccine, but it's the first major rollout.

Adenoviruses have been used for some other things. So they thought one shot would work. And that's what they did. I can't-- until they release phase III, efficacy is going to be hard to say. The phase I on the J&J vaccine looked really good. Like 95% of people were producing high level antibodies from the one dose. But until we actually get how many of those were protected from illness data, we can't say for sure if they're quite as good or even better than the two we currently have.

JAY BLANTON: And is part of one of the maybe the bright spots of these kind of vaccines-- particularly the Pfizer and Moderna that are on that platform you talked about-- one of the things I've heard or read is that this could be the future, that we could have much more rapidly developed vaccines because they're operating off of this common platform and it makes it just that much easier and more flexible to do this?

REBECCA DUTCH: They just need to know what mRNA to put in there. So all the way back in January when we first got the sequence for this virus, they were already getting that out. And they were trying-- I mean, the vaccines were all getting up and going at that point. But for the mRNA vaccine, they didn't have to worry about, how can I make this protein? How do I make it stable? How do I do this? They just have to make the mRNA. So it could be a very good platform for vaccines for going forward in the future.

KODY KISER: Is this type of vaccination rollout-- I mean, if we can get this ramped up because of this platform, being able to build this quickly and get this out, and then the efficacy of the vaccines themselves-- could we, if things go well, if all the things fall into place, could we see a drop off of cases that could possibly be maybe not as rapid, but nearly as rapid as we saw the spread of this in the first place?

REBECCA DUTCH: Well honestly, if we could just vaccinate everybody in the next month and a half, then yeah, we'd see a rapid drop. I think a lot of it's going to depend on how rapidly we roll this out. We've actually done very well in Kentucky, very well. A lot of states have not done nearly as well at vaccine rollout. And what percentage of people take the vaccine-- because depending on the surveys, as you see, as many as 40% of people say they don't want to be vaccinated.

And they, then, remain-- even if they're not a category that's likely to die, if this cuts transmission, which we're waiting for the final numbers, but it very likely does-- if other people aren't vaccinated, they remain a pool of virus that becomes an issue. So we're going to have those two things, really, to deal with.

The other thing we'll have to deal with over the next year, I think, a lot of [INAUDIBLE] people are still in the hospital. And second, it's a good percentage of people who are having long-term effects from COVID. And that's going to be a major issue that we have to deal with. I mean that from the health standpoint.

We'll also have a lot of major issues related to just trying to get society and people back to being OK, because a lot of people still-- this has been a really, really hard year for a lot of people. It's going to take some time.

KODY KISER: Are we seeing enough cases in an age range under 60, under 50, that is more than just an anomaly? Should people-- I mean, there should be some serious considerations.

REBECCA DUTCH: Oh, there are. Yeah. Yes, if you're in your 20s, your chances of dying of COVID are very small. But they're not 0. If you're in your 50s, your chances aren't actually that small. I think-- and I wish I had the exact numbers from when they did it. There was a good paper in Science that did. And basically, they took studies from around the world and tried to make risks for age group. And by that point, we were probably 1% or above. I don't really want to get something that I have a 1 in 100 chance of dying from.

And I actually know plenty of people that are acquaintances or are friends of mine who've had it who, weeks to months later, still don't feel completely right. So there are other things that people are going to have to deal with related to it. So there are major risks. And it's not just for people who are over age 70.

KODY KISER: And I think about that, too, with people who are in their 20s and their 30s that might get this, might not have, really, any kind of severe symptoms. But eventually over time, I feel like we're going to discover in the next 5, 10, 15 years that there are going to be some long-term consequences for people's overall health.

REBECCA DUTCH: Well, I think we're-- for the people in their 20s, the thing that I would worry about, for those who actually get the infection, I think in some cases we'll have heart lung issues that we have to really track. Luckily, it's not the norm. It's nowhere near everybody. But those will show up.

In that age range, the other thing I'm really concerned about, though, is mental health issues. And that's from the social isolation related to this. And balancing all of those concerns is a real challenge. I mean, I know when we reopened the university in the fall, that was really on the minds of a lot of us as we discussed it. What are their risks from COVID? What are their risks if they can't come back? What are their risks if they're home alone? And those things are also things we're going to have to really wrestle with now because we have major issues of mental health across the country in all age groups, but definitely in the teens and 20s right now.

JAY BLANTON: That's kind of a pivot point, maybe, in our conversation. So you talked about the university coming back in the fall and what the institution did. You are a faculty. You've been very involved. You're on the [? START ?] committee, which has helped with all the medical recommendations and testing recommendations that the university has followed.

You also, as a faculty member, made the decision to teach in person in the fall. Can you talk a little bit about why you made that decision, why you thought it was important, what you think that means, and how we ought to think about that going forward?

REBECCA DUTCH: Yeah. So I am a firm believer in the strength of residential education where you get to have discussions with your professor, with the rest of the class. I know when I was a student, I actually liked going to class. My youngest is a junior at Michigan State. I know he has an in-person class this semester. He's so glad to at least have one.

It's really hard to just sit in your room or your apartment by yourself and be on class, and then sit alone the rest of the day. So both educationally, there's things I think we can do in class that are not as easily done remotely. And from a social aspect, if we could set things up so that people could safely attend class, then it provides one outlet for those concerns about social isolation.

So for all of those reasons, I thought it was very important, if possible, to teach a class. I co-teach a virology class with another really outstanding-- in this case, an emeritus person who comes back just to teach a few classes and is in her 70s. We both taught in person the whole semester.

It's a smaller class, about 20 people. We're teaching virology. I can't think of a better time to be teaching it-- very, very discussion-heavy course. And so we made the decision that if we could teach in person, we would.

And we set up everything safely, as I'm sure you guys have talked about before. There's all of the tracking of cases on campus. We really did not have an issue with cases being transmitted in classrooms. The classrooms were nicely set up with distance between people. The mask mandate was present. The one additional thing I did do, because-- I went ahead and put on eye protection, just because over time, that can be an issue, and because for myself and my co-teacher, we're both above the age of 50. So we wanted to just be a little-- add some extra precautions.

I enjoy teaching in person. Even in my mask, et cetera, I could give a lecture. We can have discussions. We did have to do it so that some students could do it remotely, because there were some cases where someone, that was what they needed to do. And so they'd be on the computer. Other people would be there in class.

But we had, up until the very, very end when we went to the last two because it was almost the end and we were having an increase here in Kentucky [INAUDIBLE] maybe to slow down, we went to those remote. But everything else was done in person. And I think that that getting out and engaging was part of your day, and what feels a little more normal is important.

KODY KISER: Did you find that during that process during the semester that-- did you have to balance, in a sense, some of your teaching time in the class period along with maybe some not necessarily counseling, but at least some dialogue between students where they could-- if they needed to process some things? I mean, did that happen?

REBECCA DUTCH: Well, I did. And actually, that's one nice thing about teaching a virology class, because I could feel completely justified in doing it. We actually started each of our lecture periods with a discussion period about any new questions about COVID, any concerns about what's going on, anything you guys want to talk about that you read in the paper, because this was such a-- I mean, what a life-learning time, to sit there and be studying virology. And you could pick up the paper and ask, well, what about this? Or, I saw this on Facebook. Is this true?

So we always started that way. And some of what would come out were concerns. Hey, I don't think this was as safe as I thought it was going to be when I went to here. What do you think about this? What do you think about restaurants? What do we think about this? So we could have those conversations. And it was actually a really nice way to do it.

JAY BLANTON: As always, there's conversation going on, too, about what the future looks like and what does normal look like? And how do you think about that? And what would you tell people?

REBECCA DUTCH: I think by summer, we'll get back to closer to what we think of as normal, meaning by end of summer, I'm guessing we won't be masked. We'll probably hit a lot more situations where we can be without masks, if we're in situations where everyone in the room has been vaccinated. And things will really start to re-open up. I mean, I love Disney World. And I think by fall, you'll probably be able to go back in a safe circumstance.

I think some things will stay a little bit different. Some of us have adjusted more to online. And I think there'll be more online work. But I think we've also maybe learned some of the limits from that. I know some students love online education. Many of them, however, find that it's really difficult to dig as deeply as they would in an in-class situation. A little harder to stay-- I know for me, it's harder to stay focused.

And I think that students have found that. It's harder to do a discussion on Zoom in that kind of situation, particularly to make sure everyone gets involved. And so I think that we'll find some renewed enthusiasm for some of the things like getting to go to your real class without your mask on. I imagine in the fall that it's going to be pretty darn fun for people to get to go back to what feels more normal.

But I also think we'll all be a little more cautious now. And it's just probably wise, I think, as a world. We're a little more aware of the risks. Virologists have always known they were there. The rest of the world knows it's there, now, and probably a little more nervous every time we hear about some new pathogen that seems to be popping up somewhere.

KODY KISER: Just want to-- kind of a quick tangent that's kind of related to this, but also just kind of related to overall, I guess, our health system. What were our flu numbers like this year? Did we see lower transmission of the flu? Did we see a reduced severity of the flu this year? How did that kind of factor into things?

REBECCA DUTCH: So we're still in the middle of what should be the massive flu season. January is usually one of the worst months. So far, flu has been extremely reduced in this country. And that is actually consistent with some of the things we've seen, reports out of Australia, New Zealand, and then South America, who get their flus-- they're in the southern hemisphere, so they get flu earlier than we do. They basically flip their seasons. They also had a lot less cases.

So why is that? And it's great news, because it means at least our hospitals aren't getting inundated with flu cases at the same time we're dealing with COVID cases. Why might it be? One, a lot of places pushed vaccination just to try to reduce any chances of having your ICU taken up with flu cases, because generally in the normal flu season, we have patients with flu in the ICU almost all the time during the big flu onslaughts.

Second, the same things that help reduce COVID-- masking and distancing-- they're going to reduce transmission of any respiratory virus. So flu is going to have a much harder time transmitting. And third, there seems to be this interesting thing that viruses almost have niches. So one year, you might see this one seems to be winning. And then the next year, it might be the next one.

So back in 2009 when H1N1 came out, we had almost no seasonal flu that year. Should have still been there, but we just see almost no cases of it. So it could be all of those factors contribute. But that is a piece of really good news. We don't have a lot of flu. We have some. It's still there, some people still getting diagnosed, but not in the crisis numbers that we've had some years.

KODY KISER: So I guess the takeaway, for the most part, continue to stay the course right now, wearing a mask, social distancing, washing hands. Those have been consistent from the beginning of this process or beginning of this journey we've been on. Are we-- I don't feel like we're at a place right now where we need to have a lot of people going out to eat, things like that. But general trips to the grocery store, things like that, are we in a better place to where we kind of have a handle on it?

REBECCA DUTCH: Well, the challenge there is if you're vaccinated, you're in a better place. Even after one dose, if someone has to go in the store, I think it should be myself and not my husband, who hasn't been vaccinated yet. After two, yeah, I'll be in a much better place.

But there's a lot of CoV-2 spreading in the community. So compared to, say, last summer, your chances in that Kroger or that Meyer, that you happen to be in the aisle with someone with it, are higher. And if indeed, one of these variants that transmits better starts moving more rapidly through Kentucky, then your risks for transmission go up. So at least in the next few months, I would not view yourself as any safer in any of those stores, unless you had both vaccines and you've got a week past.

Other than that, I would take every single precaution, because it would really be a pity for a lot of people to be that close to the light at the end of the tunnel, and end up with this.

KODY KISER: We want to be mindful of the time that we've had with you today. Is there anything we haven't mentioned or anything we haven't touched upon that you feel like might be important to get out to people listening?

REBECCA DUTCH: I think the biggest things are to keep listening and understanding that the research is ongoing. New stuff's coming out on a daily basis. So for instance, if you have concerns about the vaccines, look into all the research. Read the stuff about it. Understand just how much has been done to look at safety.

If you have concerns, are the new variants going to be blocked by these vaccines? You're going to have new stuff coming out all the time. So when advice changes or new advice gets added, that's because tens and thousands and hundreds of thousands of people around the world are doing research to try to update their recommendations to the best possible at that moment. So be prepared for some changes.

And as we move towards the summer, we are going to have changing recommendations as more people are vaccinated, about what is safe. So keep your ears out and listen carefully and follow the guidelines that come out.

KODY KISER: All right. Excellent advice and guidance, Dr. Rebecca Dutch. Thanks so much for being with us. We appreciate your time. And continue to do the hard work that you're doing. And we continue to appreciate that.

REBECCA DUTCH: All right, well thank you very much.

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